• Miscellaneous neurodegenerative disorders

Xenazine Generic Name & Formulations

General Description

Tetrabenazine 12.5mg; 25mg+ (+scored); tabs.

Pharmacological Class

Vesicular monoamine transporter 2 (VMAT2) inhibitor.

How Supplied


Generic Availability


Xenazine Indications


Huntington's chorea.

Xenazine Dosage and Administration


Individualize. Initially 12.5mg once daily in the AM, then 12.5mg twice daily after one week. Titrate slowly at weekly intervals by 12.5mg. Doses of 37.5–50mg/day should be given in a 3 times/day regimen. Max 25mg/dose. Patients who require >50mg/day should be genotyped for CYP2D6. Poor CYP2D6 metabolizers: max 25mg/dose and 50mg/day; extensive and intermediate metabolizers: max 37.5mg/dose and 100mg/day. Concomitant strong CYP2D6 inhibitors: max 25mg/dose and 50mg/day; moderate to weak CYP2D6 inhibitors: not evaluated. Retitrate if therapy interrupted for more than 5 days.


Not established.

Xenazine Contraindications


Untreated or inadequately treated depression. Suicidal ideation. Hepatic impairment. During or within 14 days of MAOIs. During or within 20 days of stopping reserpine. Concomitant deutetrabenazine or valbenazine.

Xenazine Boxed Warnings

Boxed Warning

Depression and suicidality.

Xenazine Warnings/Precautions


Monitor for emergence or worsening of depression, suicidality, or unusual changes in behavior. History of depression or suicidal ideation. Avoid in congenital long QT syndrome, history of cardiac arrhythmias. Bradycardia. Hypokalemia. Hypomagnesemia. History of breast cancer. Discontinue if neuroleptic malignant syndrome (NMS) occurs. Monitor for parkinsonism, akathisia, restlessness, agitation; may need to reduce dose or discontinue treatment. Poor CYP2D6 metabolizers. Reevaluate periodically. Pregnancy. Nursing mothers.

Xenazine Pharmacokinetics

See Literature

Xenazine Interactions


See Contraindications. Avoid concomitant drugs known to prolong QT interval (eg, chlorpromazine, haloperidol, thioridazine, ziprasidone, moxifloxacin, quinidine, procainamide, amiodarone, sotalol). Potentiated by strong CYP2D6 inhibitors (eg, paroxetine, fluoxetine, quinidine); see Adult. Increased risk of parkinsonism, NMS, akathisia with neuroleptics, dopamine antagonists. Additive CNS depression with alcohol, other CNS depressants.

Xenazine Adverse Reactions

Adverse Reactions

Sedation/somnolence, fatigue, insomnia, depression, akathisia, anxiety/anxiety aggravated, nausea, upper respiratory tract infection; parkinsonism, QTc prolongation, orthostatic hypotension, hyperprolactinemia, extrapyramidal effects, dysphagia, potential for long-term ophthalmologic effects.

Xenazine Clinical Trials

See Literature

Xenazine Note

Not Applicable

Xenazine Patient Counseling

See Literature